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Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

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World Journal of Gastrointestinal Endoscopy 2017年第4期9卷 183-188页

作者： Vinay Chandrasekhara Joyce Koh Lakshmi Lattimer Kerry B Dunbar William J Ravich John O Clarke Division of Gastroenterology and Hepatology Department of Internal Medicinethe Johns Hopkins Medical Institutions Gastroenterology Division Department of Internal MedicineUniversity of Pennsylvania Health System Perelman Center for Advanced Medicine South Pavilion Gastroenterology and Liver Diseases Depart-ment of Internal Medicinethe George Washington University Division of Gastroenterology and Hepatology Department of MedicineUniversity of Texas Southwestern Medical SchoolDallas VA Medical Center

To evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement. METHODSAll balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES). RESULTSFour hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker’s diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques (P = 0.5). Successful symptom resolution was also not significantly affected by dilator size, oropharyngeal dysfunc

关键词： cricopharygeal dysfunction Cricopharyngeal bar Dysphagia Esophageal dilatation Endoscopic balloon dilation

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